Femur Flap for Tibial Reconstruction: Percent Circumference Required to Convey a Mechanical Advantage over the Fibula

ABSTRACT The fibula flap is commonly used to reconstruct the tibia. This has risk of postoperative fracture despite long-term non–weight bearing. A flap using noncircumferential distal femur is proposed. This study is to determine the circumference of femur required to produce greater strength than the fibular flap. Femurs and fibulas were harvested from eight cadavers. The structural strength of fibula and femur flaps was assessed using three-point bend. Compression testing was performed on osteotomized and whole femurs to assess donor site morbidity. The 35% flap (mean maximum force at fracture 869 N) was not significantly stronger than the fibula flap (626 N; P > 0.05). The 40% flap (1225 N) was significantly stronger than the fibula flap (P